Project information

Alopecia UK funds invested: £10,000 

When:  December 2019 - July 2023

Project type:  Clinical Research

Project Lead:  Dr Amr Salam

Length of project: 3 years

Research Institute:  St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust

Condition of interest:  Alopecia Areata, Coeliac Disease

Funds being used for:  Administrative support and a statistician (Staffing costs)

Research question:

Does an association exist between coeliac disease (CD) and alopecia areata (AA), and if so, is there sufficient evidence to suggest that a gluten-free diet could stimulate hair regrowth in some patients? Furthermore, do such patients experience micronutrient deficiency due to malabsorption secondary to CD?

Justification for research project:

An association between alopecia areata (AA) and coeliac disease (CD) was first reported in 1995, and since then, although genetic similarities have been identified, a clinical association between these conditions remains undetermined. Furthermore, there is a lack of data studying the impact of CD on micronutrient malabsorption and subsequent effects on the hair cycle.

This retrospective study will look at the medical notes of all paediatric patients diagnosed with alopecia areata, totalis or universalis presenting to our tertiary hair clinic over the last 20 years. In order to determine the prevalence of associated AA and CD in the study population, Dr Salam will determine whether a diagnosis of CD was confirmed on endoscopy, a gluten free diet was established, the impact of gluten free diet on hair regrowth, micronutrient profiles at the time of diagnosis, the presence of any micronutrient deficiencies, whether replacement was initiated, and if this had an impact on hair regrowth.

Who is leading the project:

Dr Amr Salam is a Consultant Dermatologist and Honorary Senior Lecturer at the St John's Institute of Dermatology at Guy's and St Thomas' NHS Foundation Trust, and King's College London. Amr completed a 1-year senior clinical fellowship in Medical Dermatology and Medical Education where he gained skills in the tertiary level management of eczema, psoriasis and hair disorders. He has undertaken an externship at the Yale New Haven Hospital, USA, Dermatology Department. Amr is a lead for postgraduate education at the St John’s Institute, and Director of the world’s first distance learning qualification in specialist dermatology for clinicians – the St John’s Diploma (www.stjohnsdiploma.com). Dr Salam has completed a Masters in Clinical Education and is the Course Director for 2 national & international courses. He sits on the British Association of Dermatologists Undergraduate Workstream. Dr Fenton is a consultant Dermatologist and has been running the Hair Research Clinic at St Thomas’s Hospital since 1983. He provides the only dedicated paediatric NHS hair clinic in the UK.

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What were the results? (Update shared April 2025)

The project suffered severe delays due to the COVID pandemic and staff shortages, but has now been completed and the results were recently presented at the American Academy of Dermatology conference in March 2025. They are now working on publication in a scientific journal which will be shared here when available. 

The researchers provided the following summary of the project: 

"This study explored whether children with alopecia areata (AA) are more likely to have coeliac disease (CD) – an autoimmune condition triggered by gluten, a protein found in foods such as wheat, barley, and rye. Coeliac disease has been linked to other important health issues, including weight loss, nutrient deficiencies, infertility, and an increased risk of gut lymphoma (a type of white blood cell cancer).

They looked at the medical records of 353 children with AA who attended their specialist NHS children’s hair clinic at Guy’s and St Thomas’ NHS Foundation Trust over a period of 8.5 years. The medical history and clinical examination findings were reviewed. This included their type of hair loss, possible triggers for the condition (such as stress or illness), and whether they had family members with autoimmune diseases. We also looked at coeliac disease screening blood results, and blood levels of key nutrients important for hair health, including iron, zinc, vitamin B12, and folate.

They found that only 1.8% of the children tested had a positive screening blood test for CD. Of these, only one child had the diagnosis of CD confirmed with a stomach camera test and gut biopsy. This is about the same rate as in the general population, so, in their patient population, children with AA do not appear to be at higher risk of CD. Similarly, they did not observe significant issues with nutrient deficiencies.

The findings from this study may help doctors avoid unnecessary blood tests and reassure families, reducing both anxiety and the burden of healthcare costs. By showing that routine screening for coeliac disease and automatic supplementation of micronutrients are not typically necessary in children with AA, this research supports a more focused and evidence-based approach to care. However, further studies are needed to investigate whether certain subgroups of patients might still benefit from targeted interventions. Specifically, research into personalised dietary plans and the therapeutic impact of correcting specific deficiencies may offer promising directions. Such work could eventually lead to more refined, individualised management strategies that optimise outcomes for children affected by AA."